Association of Premorbid Adjustment with Symptom Profile and Quality of Life in First Episode Psychosis in a Tertiary Hospital in Tehran, Iran

Article excerpt

Objective: Poor premorbid adjustment has been reported to be a predictor of more severe psychotic symptoms and poor quality of life in such psychotic disorders as schizophrenia. However, most studies were performed on chronic schizophrenic patients, and proposed the likelihood of recall biases and the effect of chronicity. The aim of this study was to investigate these factors in a sample of first episode psychotic patients, as a part of Roozbeh first episode psychosis project (RooF).

Method: Premorbid adjustment was assessed using Premorbid Adjustment Scale (PAS) in 48 patients with the first psychotic episode who were admitted to Roozbeh Psychiatric Hospital. The severity of symptoms was measured using Positive and Negative Scale (PANSS) in three subgroups of positive, negative and general subscales. Quality of life was measured using WHO QOL ,and Global Assessment of Functioning (GAF) was also measured.

Results: The mean age was 24 years. Poor Premorbid adjustment in late adolescence was significantly associated with more severe symptoms according to PANSS negative symptoms (p=0.019, r=0.44). Furthermore, sociability and peer relationship domains had a positive correlation with PANSS negative subscale scores (r=0.531, p=0.002 and r=0.385, p=0.03, respectively). There were no significant differences between males and females in premorbid adjustment. Furthermore, this study failed to show any differences between affective and non-affective psychosis in premorbid functioning .

Conclusion: Our study confirms poor premorbid adjustment association with more severe negative symptoms and poor quality of life in a sample of Iranian first episode psychotic patients.

Premorbid psychosocial adjustment has attracted great attention in studies that tried to find factors associated with different clinical course and outcome of patients who were affected by schizophrenia. Kraepelin and Bleuler were the first to note that there are certain social and intellectual impairment in schizophrenic patients long prior to the onset of the psychotic symptoms (1, 2). Since then there has been extensive evidence that poor childhood and adolescent psychosocial adjustment is manifested in many, but not all, patients with schizophrenia (3).

Premorbid adjustment is defined as the ability of a person to make social and intimate relationships as well as their academic achievements before the onset of psychotic symptoms (4). Poor premorbid functioning has been reported to have positive correlation with early and insidious onset, male sex, poor clinical outcome, negative symptoms, neurocognitive deficits, and poor response to treatment (2, 5-7). Poor premorbid functioning has also been reported to be the strongest overall predictor of outcome (4).

Premorbid psychosocial adjustment proposed neurodevelopmental nature of schizophrenia (7). Some studies suggested that schizophrenic patients with poor premorbid adjustment may represent a special biological subtype of the disorder by some characteristics such as early age of onset, negative symptoms, and poor response to treatment. Data proposed that poor premorbid adjustment reflects the impact of schizophrenia susceptibility genes and might be considered as an intermediate phenotype marker of schizophrenia (2).

Many studies investigated the relationship between premorbid functioning and different aspects of schizophrenia on a sample of chronic schizophrenic patients with a long period of years passed from their illness onset. Gathering information after such a long time increased the likelihood of potential bias and therefore the data became inaccurate and incomplete (8). Thus, it is not yet clear whether the reported association of poor premorbid with poor response to treatment or negative signs is a real association. …